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Chase
Chase
H. Peter Chase, MD
Professor of Pediatrics Barbara Davis Center Aurora, CO Keystone Conference Wednesday, July 16, 2008
How common are glucose levels <60mg/dl during the night in children with T1D?
French (i) and Australian (ii) data showed approximately 50% of children with low BG (<60mg/dl) during the night (on NPH bid) DirecNet data (one night in hospital with blood sugars every 30 min.)
A) 2001-2002: 39 of 91 (43%) low BG
(44% of children on insulin pumps/56% on NPH)
i) ii)
Beregszaszi M, et al. J Pediatr. 131, 27, 1997 Porter PA, et al. J. Pediatr. 13, 366, 1997
Snapshot of BG levels
> 300
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E. Prevention of Complications?
Barbara Davis Center for Childhood Diabetes May 2008
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B. Transmitter C. Receiver/Monitor
*(Understanding Pumps and CGMs, p.103)
Barbara Davis Center for Childhood Diabetes May 2008
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A)Sensor
(p.103)
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B)Transmitter
(p.103)
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C)Receiver or Monitor
(p.103)
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i) TREND GRAPHS*
Trend graphs Knowing a glucose level is 240 mg/dl may not be as important as knowing the trend.
*(Understanding Pumps and CGMs, p.103)
Barbara Davis Center for Childhood Diabetes May 2008
ii) ALARMS (p.109) Can warn patients of current or projected high and low blood sugar
Threshold alarms: warning when glucose is below or above a set value (all devices)
Barbara Davis Center for Childhood Diabetes May 2008
2) Retrospective
A. Modal Day Graphs (p.113) B. Pie Chart (p.114)
C.Statistics (p.113)
*(Understanding Pumps and CGMs, Chapter 17, p.109)
Barbara Davis Center for Childhood Diabetes May 2008
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C) STATISTICS (p.113)
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Questions?
The presentation by the nurses will be next. You will then examine the CGMs from 3 companies.
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30
13 wks
6.80.7%
(p=0.02)
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HbA1c
8.5
8.0 7.5
N=15 N=15
HbA1c (%)
*
N=15 N=13
N=12
7.0
6.5
N=15
N=15
N=13
6.0 5.5
Baseline
* p=0.004
Week 7
Week 13
Week 26
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Black dots denote mean values and boxes denote median, 25th and 75th percentiles. vs. baseline; p=0.002 vs. wks 9-13.
80%
70%
N=15 N=13 N=15 N=13 N=11 N=13
N=11 N=11
60%
50%
N=14 N=15 N=15 N=15
N=9
N=11
40%
30%
Baseline
Wks 1-4
Wks 5-8
Wks 9-13
Wks 14-17
Wks 18-21
Wks 22-26 33
12%
10%
8%
N=13
6% 4%
N=13 N=11
N=11
N=11 N=11
N=15 N=9
2% 0%
N=14
Baseline
Wks 1-4
Wks 5-8
Wks 9-13
Wks 14-17
Wks 18-21
Wks 34 22-26
Caucasian
HbA1c T1D duration MDI Regimen Glargine + RAIA* Glargine + RAIA* + NPH Other
25 (93%)
7.9 1.0% 4.0 3.1 yr 21 (78%) 5 (16%) 1 ( 4%)
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**
* p = 0.02 ** p = 0.03
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160 * 140
120
**
100
* p = 0.004 ** p = 0.17
Wks 9-13
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Q. Why combine insulin pumps (CSII) and Continuous Glucose Monitors (CGM)?
(p121) A: They complement each other tremendously and provide the most state of the art diabetes care available. The CGM helps with: Cannulas dislodging
Now let me get this right, Dr. Chase You want the elves to make an artificial pancreas? THANK YOU
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